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Abstract Despite the growing recognition of the importance of street vendors and informal markets for urban life and the economy globally, research attention has tended to focus on essential products such as food or clothes and paid less attention to cultural products, such as antiques where potential gender, and other socio-demographic, differences in vending and buying behaviours may systematically differ. To explore these issues, this study employed spatial–temporal behaviour mapping (STBM) and field observations (n = 8587) at Beijing’s Panjiayuan antiques “ghost market” a term reflecting its previously illegal/underground and mobile nature. We monitored four representative sites within the market, four times a day for six consecutive days. The data included five categories of behaviour, four age groups, and two genders. Data were recorded and analysed using ArcGIS. Results showed that, unlike common marketplaces, the antique market is primarily frequented by male vendors and buyers, replicating patterns seen in ancient Chinese paintings of men being involved in the trading of “non-essentials”. Nonetheless, we found differing gender balances depending on the time and day of the week, different age groups, and spatial settings in different market areas. We summarise the nuanced relationships between the emerging gender spatio-temporal behaviour patterns and three key factors, spatial characteristics, physical activities and the social division of labour, in the Chinese context. The study reveals how the varied spatial–temporal patterns of a large antique “ghost market” raise long-established issues of equity and inclusivity and provide empirical insights that could inform decision-making and urban planning, such as better use of dynamic lighting provision to encourage a more gender-balanced experience.

Abstract Per- and polyfluoroalkyl substances (PFAS) are a large class of synthetic compounds, many of which are persistent, mobile and toxic (PMT). The sheer number of PFAS makes a substance-by-substance based approach to regulating this group unfeasible. Given the known risks of many PFAS, a precautionary approach (i.e., the Essential Use Concept; EUC) has been called for, whereby any substance is assumed to be harmful and should be phased out, unless it is shown that: (a) the use of this substance is necessary for health and safety, or is critical for the functioning of society and (b) there are no available technically and economically feasible alternatives. While experts, including chemists and toxicologists, are well-placed to assess the second criteria, determining what is necessary for the “functioning of society” requires a wider consideration of societal beliefs and preferences and greater involvement of various interested and affected parties, especially those whose voices are less heard but may be most vulnerable. The aim of the current paper is to provide a preliminary framework and research agenda outlining why and at what points in the essential use decision-making process broader societal perspectives are required, and how such ‘social data’ can be collected. The ultimate goal is to improve chemicals management by supporting citizens in becoming more informed and engaged participants in relevant debates and policies, including in how to operationalise the EUC.

Abstract Increasing evidence indicates contact with nature supports mental, physical and social health. However, beyond a widely reported number of barriers to nature contact, the constellation of motivations for human contact with nature is under‐theorised and under‐studied. We begin to develop indicators of autonomous and controlled motivations for nature contact informed by self‐determination theory. These include intrinsic motivation (i.e. enjoyment), integrated regulation (alignment with identify and life goals), identified regulation (a means to an end), introjected regulation (emotional reasons like guilt avoidance) and external regulation (such as peer pressure). We compare these motivation indices in a nationally representative sample of 5082 adults in Australia in 2022 with the Nature Relatedness Scale (NR6), and also test associations between them and five outcomes: time spent in nature, smartphone use in nature, interest in nature prescriptions, physical activity and self‐rated health. Statistical analyses were adjusted for potential confounding. Results demonstrate people have complex mixtures of motivations with varying potency for visiting natural settings and the extent to which those motives are autonomous or controlled matters for what they do, and the benefits accrued. For example, our analyses show that more direct considerations of intrinsic, integrated and identified forms of autonomous motivation have superior explanatory power than the NR6 for time spent in nature, interest in nature prescriptions, adherence to physical activity recommendations and self‐rated health. External regulations emphasising peer approval were associated not only with no additional time in nature but also with more distractive activities when in natural environments, as defined by more smartphone and social media use while there. While introjected regulations emphasising guilt avoidance were associated with increased nature contact, they were similarly associated with time spent on smartphones and social media when in natural environments, which has been shown to undermine restoration. Synthesis and applications: We need to formally measure autonomous and controlled motivations for nature contact to better understand both why some people visit natural environments, and whether they are mindfully maximising the health benefits of those experiences. This will help to inform robust nature‐based interventions that are acceptable, effective and sustainable for everyone. Read the free Plain Language Summary for this article on the Journal blog.

Physical activity (PA) reduces the risk of several non-communicable diseases (NCDs). Natural environments support recreational PA. Using data including a representative cross-sectional survey of the English population, we estimated the annual value of nature-based PA conducted in England in 2019 in terms of avoided healthcare and societal costs of disease.Population-representative data from the Monitor of Engagement with the Natural Environment (MENE) survey (n = 47,580; representing 44,386,756) were used to estimate the weekly volume of nature-based recreational PA by adults in England in 2019. We used epidemiological dose–response data to calculate incident cases of six NCDs (ischaemic heart disease (IHD), ischaemic stroke (IS), type 2 diabetes (T2D), colon cancer (CC), breast cancer (BC) and major depressive disorder (MDD)) prevented through nature-based PA, and estimated associated savings using published costs of healthcare, informal care and productivity losses. We investigated additional savings resulting from hypothetical increases in: (a) visitor PA and (b) visitor numbers.In 2019, 22 million adults > 16 years of age in England visited natural environments at least weekly. At reported volumes of nature-based PA, we estimated that 550 cases of IHD, 168 cases of IS, 1,410 cases of T2D, 41 cases of CC, 37 cases of BC and 10,552 cases of MDD were prevented, creating annual savings of £108.7million (95 % uncertainty interval: £70.3million; £150.3million).Nature-based recreational PA in England results in reduced burden of disease and considerable annual savings through prevention of priority NCDs. Strategies that increase nature-based PA could lead to further reductions in the societal burden of NCDs.

A healthy ocean is essential for human health, and yet the links between the ocean and human health are often overlooked. By providing new medicines, technologies, energy, foods, recreation, and inspiration, the ocean has the potential to enhance human health and wellbeing. However, climate change, pollution, biodiversity loss, and inequity threaten both ocean and human health. Sustainable realisation of the ocean’s health benefits will require overcoming these challenges through equitable partnerships, enforcement of laws and treaties, robust monitoring, and use of metrics that assess both the ocean’s natural capital and human wellbeing. Achieving this will require an explicit focus on human rights, equity, sustainability, and social justice. In addition to highlighting the potential unique role of the healthcare sector, we offer science-based recommendations to protect both ocean health and human health, and we highlight the unique potential of the healthcare sector tolead this effort.

Abstract Natural environments can promote well-being through multiple mechanisms. Many studies have investigated relationships between residential green/blue space (GBS) and well-being, fewer explore relationships with actual use of GBS. We used a nationally representative survey, the National Survey for Wales, anonymously linked with spatial GBS data to investigate associations of well-being with both residential GBS and time in nature (N = 7631). Both residential GBS and time spent in nature were associated with subjective well-being. Higher green-ness was associated with lower well-being, counter to hypotheses (predicting the Warwick and Edinburgh Mental Well-Being Scale (WEMWBS): Enhanced vegetation index β = − 1.84, 95% confidence interval (CI) − 3.63, − 0.05) but time spent in nature was associated with higher well-being (four hours a week in nature vs. none β = 3.57, 95% CI 3.02, 4.13). There was no clear association between nearest GBS proximity and well-being. In support of the equigenesis theory, time spent in nature was associated with smaller socioeconomic inequalities in well-being. The difference in WEMWBS (possible range 14–70) between those who did and did not live in material deprivation was 7.7 points for those spending no time in nature, and less at 4.5 points for those spending time in nature up to 1 h per week. Facilitating access and making it easier for people to spend time in nature may be one way to reduce socioeconomic inequalities in well-being.

Abstract Societies value the marine environment for its health-promoting potential. In this preregistered study, we used cross-sectional, secondary data from the Seas, Oceans, and Public Health In Europe (SOPHIE) and Australia (SOPHIA) surveys to investigate: (a) relationships of self-reported home coastal proximity and coastal visits with self-reported general health; (b) the potential of both to buffer income-related health inequalities; and (c) the generalizability of these propositions across 15 countries (n = 11,916–14,702). We find broad cross-country generalizability that living nearer to the coast and visiting it more often are associated with better self-reported general health. These results suggest that coastal access may be a viable and generalized route to promote public health across Europe and Australia. However, the relationships are not strongest among individuals with low household incomes, thereby challenging widespread assumptions of equigenesis that access to coastal environments can buffer income-related health inequalities.

Abstract Concern about plastic pollution, including microplastics, is high amongst European citizens, and effective actions are needed to reduce microplastic pollution. However, there is still uncertainty and debate about the major sources, impacts, and in particular the solutions. The aim of the current study was to gather expert perceptions about the risks of different microplastic sources to the natural environment and human health (measured as the likelihood and severity of negative impacts resulting from exposure), as well as the feasibility and effectiveness of different solutions. Experts were identified as scientists working on plastic. Usable responses were received from 73 experts with an average of 5 years’ experience in plastic research. Experts thought that there was currently stronger evidence for microplastic impacts on the natural environment than on human health, that, accordingly, the risks were higher, and they were more worried about impacts on the natural environment than on human health. Experts perceived tyre particles and textile fibres to be the main sources of microplastics presenting risk for both natural environment and human health. Various solutions were rated as relatively effective and feasible overall. Solutions that were rated as above-average in terms of effectiveness and feasibility included education and awareness programmes, washing machine filters, bans of plastic items, simplified design of products, and circular economy approaches. However, experts were uncertain about the effectiveness and feasibility of recovery and clean-up solutions, with overall ratings for these being below-average in comparison to other solutions earlier in the plastic life cycle. An improved understanding of expert views on these matters could inform the distribution of limited research resources and help prioritise research questions, especially with regard to potential solutions and interventions which will be critical for the success of the UN Plastics Treaty.

Nature-based solutions including urban forests and wetlands can help communities cope better with climate change and other environmental stressors by enhancing social-ecological resilience. Natural ecosystems, settings, elements and affordances can also help individuals become more personally resilient to a variety of stressors, although the mechanisms underpinning individual-level nature-based resilience, and their relations to social-ecological resilience, are not well articulated. We propose ‘nature-based biopsychosocial resilience theory’ (NBRT) to address these gaps. Our framework begins by suggesting that individual-level resilience can refer to both: a) a person’s set of adaptive resources; and b) the processes by which these resources are deployed. Drawing on existing nature-health perspectives, we argue that nature contact can support individuals build and maintain biological, psychological, and social (i.e. biopsychosocial) resilience-related resources. Together with nature-based social-ecological resilience, these biopsychosocial resilience resources can: i) reduce the risk of various stressors (preventive resilience); ii) enhance adaptive reactions to stressful circumstances (response resilience), and/or iii) facilitate more rapid and/or complete recovery from stress (recovery resilience). Reference to these three resilience processes supports integration across more familiar pathways involving harm reduction, capacity building, and restoration. Evidence in support of the theory, potential interventions to promote nature-based biopsychosocial resilience, and issues that require further consideration are discussed.

Background Cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited. Objectives To quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use. Design A retrospective, dynamic longitudinal panel study. Setting Wales, UK. Participants An e-cohort comprising 99,682,902 observations of 2,801,483 adults (≥ 16 years) registered with a general practice in Wales (2008–2019). A 5312-strong ‘National Survey for Wales (NSW) subgroup’ was surveyed on well-being and visits to green and blue spaces. Main outcome measures Common mental health disorders, general practice records; subjective well-being, Warwick–Edinburgh Mental Well-being Scale. Data sources Common mental health disorder and use of general practice services were extracted quarterly from the Welsh Longitudinal General Practice Dataset. Annual ambient greenness exposure, enhanced vegetation index and access to green and blue spaces (2018) from planning and satellite data. Data were linked within the Secure Anonymised Information Linkage Databank. Methods Multilevel regression models examined associations between exposure to green and blue spaces and common mental health disorders and use of general practice. For the National Survey for Wales subgroup, generalised linear models examined associations between exposure to green and blue spaces and subjective well-being and common mental health disorders. Results and conclusions Our longitudinal analyses found no evidence that changes in green and blue spaces through time impacted on common mental health disorders. However, time-aggregated exposure to green and blue spaces contrasting differences between people were associated with subsequent common mental health disorders. Similarly, our cross-sectional findings add to growing evidence that residential green and blue spaces and visits are associated with well-being benefits: Greater ambient greenness (+ 1 enhanced vegetation index) was associated with lower likelihood of subsequently seeking care for a common mental health disorder [adjusted odds ratio (AOR) 0.80, 95% confidence interval, (CI) 0.80 to 0.81] and with well-being with a U-shaped relationship [Warwick–Edinburgh Mental Well-being Scale; enhanced vegetation index beta (adjusted) –10.15, 95% CI –17.13 to −3.17; EVI2 beta (quadratic term; adj.) 12.49, 95% CI 3.02 to 21.97]. Those who used green and blue spaces for leisure reported better well-being, with diminishing extra benefit with increasing time (Warwick–Edinburgh Mental Well-being Scale: time outdoors (hours) beta 0.88, 95% CI 0.53 to 1.24, time outdoors2 beta −0.06, 95% CI −0.11 to −0.01) and had 4% lower odds of seeking help for common mental health disorders (AOR 0.96, 95% CI 0.93 to 0.99). Those in urban areas benefited most from greater access to green and blue spaces (AOR 0.89, 95% CI 0.89 to 0.89). Those in material deprivation benefited most from leisure time outdoors (until approximately four hours per week; Warwick–Edinburgh Mental Well-being Scale: time outdoors × in material deprivation: 1.41, 95% CI 0.39 to 2.43; time outdoors2 × in material deprivation −0.18, 95% CI −0.33 to −0.04) although well-being remained generally lower. Limitations Longitudinal analyses were restricted by high baseline levels and limited temporal variation in ambient greenness in Wales. Changes in access to green and blue spaces could not be captured annually due to technical issues with national-level planning datasets. Future work Further analyses could investigate mental health impacts in population subgroups potentially most sensitive to local changes in access to specific types of green and blue spaces. Deriving green and blue spaces changes from planning data is needed to overcome temporal uncertainties. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Project number 16/07/07) and will be published in full in Public Health Research; Vol. 11, No. 10. Sarah Rodgers is part-funded by the NIHR Applied Research Collaboration North West Coast. Plain language summary We investigated whether people who live near or visit green (parks, woodlands) and blue (riversides, beaches) spaces have fewer common mental health disorders (anxiety or depression), and better well-being. We considered whether changes in the amount of green and blue space around the home affected people’s mental health. We assessed the availability of local green and blue spaces. Annual exposure and access to local green and blue spaces were extracted from planning and satellite data. We linked these data to anonymised health records of 2,801,483 adults registered with a general practice from 2008 to 2019, and to survey answers about leisure visits to natural environments and well-being. We found: people who lived in greener and bluer areas were less likely to seek help for a common mental health disorder than those in less green or blue areas, with those living in the most deprived areas benefiting the most people who used green and blue spaces for leisure, especially those with the greatest levels of deprivation, had better well-being and were less likely to seek help for common mental health disorders no evidence that changing amounts of green and blue space affected how likely people were to seek help for common mental health disorders; this may be because we found mostly small changes in green and blue space, and we may not have allowed enough time between moving home and recording mental health. We found evidence for relationships between green and blue space and mental health. However, some analyses were restricted due to lack of data on changes in green and blue spaces. An important finding was that people in deprived communities appear to benefit the most. Provision of green and blue spaces could be a strategy to improve the mental health of people living in disadvantaged areas. Scientific summary Background Cross-sectional evidence suggests that living close to and spending time in and around green and blue spaces (GBS, e.g. parks, gardens, ponds, lakes, rivers) is associated with higher levels of well-being and fewer mental health problems. Some of these benefits could result from living near GBS; others (e.g. physical activity) are attributed to using GBS. There are few longitudinal studies examining whether changes in GBS affect subsequent mental health. Existing studies have largely had small cohorts, assessed change over a short time, did not investigate socioeconomic inequalities in effects and neglected to consider that some health benefits depend on using GBS rather than simple exposure. Objectives We examined the research questions: Is a greater residential exposure and access to GBS associated with the likelihood of seeking help for a common mental health disorder (CMD) in general practice? Is the association between exposure, or access to, GBS and seeking help for a CMD modified by socioeconomic disadvantage and moving home? Is a greater residential exposure associated with the likelihood of using general practice services? Is greater residential GBS exposure and access to GBS associated with higher subjective well-being or a lower likelihood of seeking help for CMD, and does intentional use of GBS for leisure mediate these associations? Are associations between residential GBS exposure and access to GBS and use and subjective well-being mediated by walking-specific physical activity and modified by socioeconomic disadvantage? Methods We used a dynamic longitudinal panel study design to retrospectively examine natural and non-random variation in GBS exposure during an 11-year period, with individual linkage to survey responses. Data sources We constructed an electronic cohort of the population of Wales using data from the Welsh Demographic Service Dataset. Household-level ambient greenness was determined from satellite imagery, access to GBS from planning records, CMD and service use from Welsh Longitudinal General Practice Dataset (WLGPD) and for a subgroup, well-being and behaviour responses to the National Survey for Wales (NSW, 2016/17 and 2018/19). Data are held in the Secure Anonymised Information Linkage (SAIL) databank. Inclusion criteria The cohort included everyone aged 16 years and over registered with a general practitioner (GP) providing patient records to the SAIL databank between January 2008 and October 2019 (‘the study period’). Those not registered with an appropriate GP, not having a Welsh residential address between January 2008 and October 2019, and not having sex/week of birth recorded were excluded from the study sample. Exposures Our primary environmental exposure was ambient greenness, measured yearly (2008–19) by mean enhanced vegetation index (EVI) averaged over a 300 m circular buffer centred on each residence. Our secondary environmental exposure was the potential for an individual to access GBS along paths/roads within 1600 m of each home, modelled for 2018. We captured changes only when individuals moved home. For research questions 1–3, GBS access was quantified by the number of potentially accessible GBS. For research questions 4–5, access was quantified as the proximity to the nearest GBS. Outcome measures For research questions 1–3, our primary outcome was seeking help for CMD in general practice, identified from practice records using a validated algorithm. Our secondary outcome was the quarterly count of general practice events. For research questions 4 and 5, our primary outcome was subjective well-being, measured by the Warwick–Edinburgh Mental Well-being Scale (WEMWBS) in the NSW. Secondary outcomes were life satisfaction (NSW) and seeking help for CMD in general practice. Self-reported time outdoors on recreational visits to GBS in Wales and walking-specific physical activity were identified (NSW). Statistical analysis Research questions 1–3 were addressed using complementary approaches: We first evaluated associations between cumulative EVI exposure and seeking help for CMD in general practice using multivariate logistic regression. Follow-up stopped when help was first sought for CMD or at the end of the study period. This time aggregated design allowed us to consider environmental exposure prior to seeking help for CMD in general practice and included differences between people. We conducted stratified analyses according to area-level deprivation (Welsh Index of Multiple Deprivation, WIMD) quintiles, home moves (none/one/more than one), history of seeking care for CMD in general practice (before January 2008) and urban-rural home location. Next, we assessed associations between longitudinal change in GBS exposures for the same individuals, and their subsequent likelihood of seeking help for CMD (primary outcome) using multivariate logistic regression. For the association with general practice services use (secondary outcome) we used Poisson regression. We used a panel design with a multilevel model structure (quarterly observations nested within individuals). We accounted for clustering of observations over time (using random effects), and unbalanced data (number of observations varying for individuals). Change in GBS exposure was modelled as a continuous variable relative to previous time periods. For people who did not move home, we modelled EVI change categories to examine in situ exposure changes. Stratified analyses were conducted for quintiles of WIMD and number of home moves. For research questions 4–5 we assessed whether GBS exposures were related to WEMWBS, life satisfaction and seeking help for CMD, and whether there was moderation by socioeconomic disadvantage. We examined whether the association between GBS exposures and WEMWBS, life satisfaction and seeking help for CMD, were mediated by time spent outdoors. Generalised additive models were used to identify any non-linear associations and inform subsequent generalised linear regression. When predicting WEMWBS, linear and quadratic terms for EVI were included and proximity to nearest GBS was categorised. For seeking help for CMD, EVI was categorised, and proximity was continuous. To assess moderation by socioeconomic disadvantage, we included interactions between material deprivation and the GBS exposures. Results The cohort included 2,801,483 individuals (99,682,902 observations). A total of 816,242 individuals (29.1%) sought help for CMD from their general practice at least once in the study period. Research question 1: Is a greater residential exposure and access to GBS associated with the likelihood of seeking health for CMDs in general practice? People who lived in homes surrounded by more ambient greenness (+ 0.1 EVI) were associated with 20% lower odds of seeking help for CMD in general practice [adjusted odds ratio (AOR) 0.80, 95% confidence interval (CI) 0.80 to 0.81]. More potentially accessible GBS (equivalent to 236 more GBS) were associated with 7% lower odds of seeking help for CMD (AOR 0.93, 95% CI 0.93 to 0.93). Every additional 360 m (0.1 unit) to the nearest GBS was associated with 5% higher odds of seeking help for CMD (AOR 1.05, 95% CI 1.04 to 1.05). People experiencing an increase of 0.1 mean EVI was not associated with seeking help for CMD in general practice (exposure change relative to: previous quarter/year/baseline AOR 1.00, 95% CI 1.00 to 1.00). Among the 1,611,581 people who did not move home (57.5% of the cohort), increases or decreases of ≥ 0.15 EVI relative to baseline were not associated with seeking help for CMD (AOR for ≥ +0.15 EVI 1.00, 95% CI 0.99 to 1.00; AOR for ≥ −0.15 EVI 1.00, 95% CI 1.00 to 1.01). Among those who moved home at least once, an increase in the number of potentially accessible GBS was not associated with seeking help for CMD in general practice (GBS increase relative to previous quarter/year/baseline: AOR 1.00, 95% CI 1.00 to 1.00). Research question 2: Is the association between exposure, or access to, GBS and seeking help for a CMD modified by socioeconomic disadvantage and moving home? Living in a home with greater EVI (+ 0.1) and more accessible GBS (+ 236) was associated with lower odds of seeking help for CMD in general practice in all deprivation quintiles and whether people moved. The odds of seeking help were lower for those who did not move (AOR non-movers 0.77, 95% CI 0.77 to 0.78; AOR moved > once 0.92, 95% CI 0.91 to 0.93). There was no evidence that EVI or GBS changes were associated with seeking help for a CMD for people living in either the most or least deprived urban areas. An increase of 0.1 mean EVI (relative to baseline) was associated with slightly lower odds of seeking help for CMD for people who moved home more than once (AOR 0.99, 95% CI 0.99 to 0.99) but not for those who moved once or had not moved. Association between different GBS exposures and seeking help for CMD in general practice were modified by urban–rural home location and a history of seeking help for CMD. Greater EVI was associated with lower odds of seeking help for a CMD for those living in rural areas (AOR 0.59, 95% CI 0.58 to 0.59) compared with urban areas (AOR 0.85, 95% CI 0.84 to 0.85). More potentially accessible GBS were only associated with lower odds of seeking help for CMD for those living in urban areas (AOR 0.89, 95% CI 0.89 to 0.89). In rural areas more GBS access was associated with higher odds of seeking help for CMD (AOR 1.10, 95% CI 1.08 to 1.12). More ambient greenness (+ 0.1 EVI) was associated with lower odds of seeking help for a CMD for those who had historically sought help for CMD (before January 2008) than people who had not (AOR 0.68 vs. 0.84). Research question 3: Is a greater residential exposure associated with the likelihood of using GP services? There was no evidence that an increase in mean EVI was associated with the number of general practice event days/quarter (adjusted incidence rate ratio relative to baseline: 1.00, 95% CI 1.00 to 1.00). Research question 4: Is greater residential GBS exposure and access to GBS associated with higher subjective well-being, or a lower likelihood of seeking help for CMD in general practice, and are these associations mediated by intentional use of GBS for leisure? Among NSW respondents with outcome measures (n = 5971) EVI was significantly related to well-being as measured by WEMWBS with a U-shaped relationship (linear regression; EVI −10.15, 95% CI −17.13 to −3.17; EVI2 12.49, 95% CI 3.02 to 21.97) and weekly time outdoors (linear relationship; EVI 43.41, 95% CI 6.85 to 79.97). Time outdoors was significantly positively related to WEMWBS [time outdoors (hours) 0.88, 95% CI 0.53 to 1.24, time outdoors (hours)2 −0.06, 95% CI −0.11 to −0.01] and life satisfaction [linear relationship; time outdoors (hours) 0.06, 95% CI 0.04 to 0.07]. There was no evidence that time outdoors mediated the relationship between EVI and WEMWBS/life satisfaction. EVI was not associated with CMD (EVI 0.4 to 0.8 vs.

Summary: Background: Living in greener areas, or close to green and blue spaces (GBS; eg, parks, lakes, or beaches), is associated with better mental health, but longitudinal evidence when GBS exposures precede outcomes is less available. We aimed to analyse the effect of living in or moving to areas with more green space or better access to GBS on subsequent adult mental health over time, while explicitly considering health inequalities. Methods: A cohort of the people in Wales, UK (≥16 years; n=2 341 591) was constructed from electronic health record data sources from Jan 1, 2008 to Oct 31, 2019, comprising 19 141 896 person-years of follow-up. Household ambient greenness (Enhanced Vegetation Index [EVI]), access to GBS (counts, distance to nearest), and common mental health disorders (CMD, based on a validated algorithm combining current diagnoses or symptoms of anxiety or depression [treated or untreated in the preceding 1-year period], or treatment of historical diagnoses from before the current cohort [up to 8 years previously, to 2000], where diagnosis preceded treatment) were record-linked. Cumulative exposure values were created for each adult, censoring for CMD, migration out of Wales, death, or end of cohort. Exposure and CMD associations were evaluated using multivariate logistic regression, stratified by area-level deprivation. Findings: After adjustment, exposure to greater ambient greenness over time (+0·1 increased EVI on a 0–1 scale) was associated with lower odds of subsequent CMD (adjusted odds ratio 0·80, 95% CI 0·80–0·81), where CMD was based on a combination of current diagnoses or symptoms (treated or untreated in the preceding 1-year period), or treatments. Ten percentile points more access to GBS was associated with lower odds of a later CMD (0·93, 0·93–0·93). Every additional 360 m to the nearest GBS was associated with higher odds of CMD (1·05, 1·04–1·05). We found that positive effects of GBS on mental health appeared to be greater in more deprived quintiles. Interpretation: Ambient exposure is associated with the greatest reduced risk of CMD, particularly for those who live in deprived communities. These findings support authorities responsible for GBS, who are attempting to engage planners and policy makers, to ensure GBS meets residents' needs. Funding: National Institute for Health and Care Research Public Health Research programme.

Abstract The effects of ‘nature’ on mental health and subjective well-being have yet to be consistently integrated into ecosystem service models and frameworks. To address this gap, we used data on subjective mental well-being from an 18-country survey to test a conceptual model integrating mental health with ecosystem services, initially proposed by Bratman et al. We analysed a range of individual and contextual factors in the context of 14,998 recreational visits to blue spaces, outdoor environments which prominently feature water. Consistent with the conceptual model, subjective mental well-being outcomes were dependent upon on a complex interplay of environmental type and quality, visit characteristics, and individual factors. These results have implications for public health and environmental management, as they may help identify the bluespace locations, environmental features, and key activities, that are most likely to impact well-being, but also potentially affect recreational demand on fragile aquatic ecosystems.

The role of neighbourhood nature in promoting good health is increasingly recognised in policy and practice, but consistent evidence for the underlying mechanisms is lacking. Heterogeneity in exposure methods, outcome measures, and population characteristics, little exploration of recreational use or the role of different types of green or blue space, and multiple separate mediation models in previous studies have limited our ability to synthesise findings and draw clear conclusions. We examined multiple pathways linking different types of neighbourhood nature with general health using a harmonised international sample of adults.Using cross-sectional survey data from 18 countries (n = 15,917), we developed a multigroup path model to test theorised pathways, controlling for sociodemographic variables. We tested the possibility that neighbourhood nature (e.g. greenspace, inland bluespace, and coastal bluespace) would be associated with general health through lower air pollution exposure, greater physical activity attainment, more social contact, and higher subjective well-being. However, our central prediction was that associations between different types of neighbourhood nature and general health would largely be serially mediated by recent visit frequency to corresponding environment types, and, subsequently, physical activity, social contact, and subjective well-being associated with these frequencies. Several subsidiary analyses assessed the robustness of the results to alternative model specifications as well as effect modification by sociodemographics.Consistent with this prediction, there was statistical support for eight of nine potential serial mediation pathways via visit frequency which held for a range of alternative model specifications. Effect modification by financial strain, sex, age, and urbanicity altered some associations but did not necessarily support the idea that nature reduced health inequalities.The results demonstrate that across countries, theorised nature-health linkages operate primarily through recreational contact with natural environments. This provides arguments for greater efforts to support use of local green/blue spaces for health promotion and disease prevention.

IntroductionMarine biodiversity loss has direct and indirect effects on human health and wellbeing. Recent European data suggest that the public is aware of this, identifying marine biodiversity protection as its top research priority in terms of oceans and human health, rated higher than issues such as plastic, chemical, and microbial pollution.MethodsThe current study aimed to better understand key sociodemographic and personality predictors of concern about marine biodiversity loss and the desire for more research into marine biodiversity protection, in an attempt to support communication efforts targeting specific sectors in society. Data were drawn from nationally representative samples of 14 European countries (n = 14,167).ResultsResults show greater concern about marine biodiversity loss and support for more research into marine biodiversity protection by older adults, females, and individuals: (i) without (vs. with) a university degree; (ii) with lower (vs. middle) incomes; (iii) who identified as politically left-wing; (iv) who visited the coast more often; and (v) those with more open, agreeable and conscientious personalities.DiscussionThese results suggest that, although concern and research support are generally high among European citizens, policy makers and communicators need to take into consideration individual-level variation.

Restoration skills training (ReST) is a mindfulness-based course in which participants draw support from a natural practice setting while they learn to meditate. Well-established conventional mindfulness training (CMT) can improve psychological functioning but many perceive it as demanding and fail to sustain practice habits. Applying non-inferiority logic, previous research indicated that ReST overcomes compliance problems without compromising the benefits gained over 5 weeks’ training. This article applies similar logic in a 6-month follow-up. Of 97 contacted ReST and CMT course completers, 68 responded and 29 were included with multiple imputation data. The online survey included questions about their psychological functioning in three domains (dispositional mindfulness, cognitive lapses, and perceived stress) and the forms and frequencies with which they had continued to practice mindfulness after the course. Former ReST participants continued, on average, to show higher dispositional mindfulness and fewer cognitive lapses compared to pre-course ratings. Improved psychological functioning in one or more domains was demonstrated by 35%, as determined by a reliable change index. Again, analyses detected no indications of any substantive disadvantages compared to the more demanding, established CMT approach. Compared to the CMT group, more ReST participants had also continued to practice at least occasionally (92 vs. 67%). Continued practice was linked to sustained improvements for ReST but not clearly so for CMT. ReST participants thus continued to use the skills and sustained the improvements in psychological functioning that they had gained in the course, further supporting the utility of ReST as a health intervention.

Abstract Living near, recreating in, and feeling psychologically connected to, the natural world are all associated with better mental health, but many exposure-related questions remain. Using data from an 18-country survey (n = 16,307) we explored associations between multiple measures of mental health (positive well-being, mental distress, depression/anxiety medication use) and: (a) exposures (residential/recreational visits) to different natural settings (green/inland-blue/coastal-blue spaces); and (b) nature connectedness, across season and country. People who lived in greener/coastal neighbourhoods reported higher positive well-being, but this association largely disappeared when recreational visits were controlled for. Frequency of recreational visits to green, inland-blue, and coastal-blue spaces in the last 4 weeks were all positively associated with positive well-being and negatively associated with mental distress. Associations with green space visits were relatively consistent across seasons and countries but associations with blue space visits showed greater heterogeneity. Nature connectedness was also positively associated with positive well-being and negatively associated with mental distress and was, along with green space visits, associated with a lower likelihood of using medication for depression. By contrast inland-blue space visits were associated with a greater likelihood of using anxiety medication. Results highlight the benefits of multi-exposure, multi-response, multi-country studies in exploring complexity in nature-health associations.

Patients feel more vulnerable when accessing community mental health programs for the first time or after being discharged from psychiatric inpatient units. Long wait times for follow-up appointments, shortage of mental health professionals, lack of service integration, and scarcity of tailored support can weaken their connection to the health care system. As a result, patients can present low adherence, dissatisfaction with treatment, and recurrent hospitalizations. Finding solutions to avoid unnecessary high-cost services and providing tailored and cost-effective mental health interventions may reduce the health system burden and augment patient support. We propose implementing an add-on, supportive text messaging service (Text4Support), developed using cognitive–behavioural therapy (CBT) principles to augment mental health support for patients attending to or being discharged from psychiatric care in Nova Scotia, Canada. This randomized controlled trial aims to investigate the effectiveness of Text4Support in improving mental health outcomes and overall mental well-being compared with usual care. We also will examine the intervention’s impact on health services utilization and patient satisfaction. The results from this study will provide evidence on stepped and technology-based mental health care, which will contribute to generating new knowledge about mental health innovations in various clinical contexts, which is not only helpful for the local context but to other jurisdictions in Canada and abroad that are seeking to improve their health care.

The Philippines, as a tropical archipelagic country, is particularly vulnerable to environmental changes affecting coastal and marine settings. However, there are limited studies investigating how these changes are perceived by the local populations who depend directly on the marine environment for their livelihoods, health, and well-being, and who are the most vulnerable to such changes. To explore these issues, we conducted an in-home face-to-face structured survey in 10 coastal communities in Palawan, Philippines (n = 431). As part of the survey, respondents were asked to comment on how important they believed a list of 22 drivers/pressures (e.g., “land-use change”) were in affecting their local marine environment. Statistical analysis of this list using Exploratory Factor Analysis suggested the 22 drivers/pressures could be categorized into 7 discrete groups (or in statistical terms “factors”) of drivers/pressures (e.g., “urbanization,” “unsustainable fishing practices” etc.). We then used ordinary least squared regression to identify similarities and differences between the perspectives within and across communities, using various socio-demographic variables. Results suggested that among the seven identified factors, four were perceived by the local communities as making the marine environment worse, two were perceived as having no impact, and one was perceived to be making the marine environment better. Perceptions differed by gender, education, ethnicity, and study site. A subsequent survey with 16 local coastal resource management experts, suggested that public perceptions of the most critical drivers/pressures were broadly consistent with those of this expert group. Our findings highlight how aware local coastal communities are of the drivers/pressures underpinning the threats facing their livelihoods, health, and well-being. Ultimately, this information can support and inform decisions for the management of local marine resources.

Despite a growing number of research outputs on the importance of nature contact during the COVID-19 pandemic, we know of no longitudinal research conducted prior to and during the pandemic among low-income and minority ethnicity populations, i.e., those that might be most affected. Furthermore, we have scant information about how and to what degree contact with nature might protect mental health or mitigate worsening of mental health during the pandemic. We filled these gaps using a subset of a longitudinal study of n = 86 individuals in low-income, predominantly African American, neighborhoods in Detroit, MI, USA. The study addressed the following research questions: (1) did self-reported use and perceived value of nature change during, vs. prior to, the pandemic; (2) did perceived access to outdoor spaces buffer people against mental health issues such as stress, anxiety and depression symptoms; or (3) did objectively measured quality of nature views from home buffer people against mental health issues, taking into account relevant covariates and pandemic experiences (e.g., loss of employment, death of a friend/relative)? While attitudes to nature improved slightly from pre- to during the pandemic, we also observed significant decreases in most types of outdoor physical activity and passive enjoyment of nature (e.g., smelling plants/rain). We found a positive association between visibility of greenspace and perceived stress and anxiety, which not only contradicts previous research findings, but was especially surprising given that overall there was a decrease in perceived stress from 2019–2020. We did not detect associations between perceived access/use of nature and mental health. However, higher depressive symptoms were associated with exposure to more COVID-19-related stressors (lost employment, death of friends from COVID-19, etc.). Taken together, our results indicate that COVID-19 may serve to prolong or exacerbate mental health issues, rather than create them, in this population and that low quality greenspace may perhaps limit the ability for nature view to buffer mental health during the pandemic.

Progress on changing human behaviour to meet the challenges of regional and global sustainability has been slow. Building on theory as well as small-scale survey and experimental evidence that exposure to nature may be associated with greater pro-environmentalism, the aim of the current study was to quantify relationships between exposure to nature (operationalised as neighbourhood greenspace, coastal proximity, and recreational nature visits) as well as appreciation of the natural world, and self-reported pro-environmental behaviour for the adult population of England. Using data from a nationally representative sample (N = 24,204), and controlling for potential confounders, a structural equation model was used to estimate relationships. Indirect effects of neighbourhood exposures via nature visits and nature appreciation were accounted for. We found positive relationships between both recreational nature visits and nature appreciation and pro-environmental behaviour across both the whole sample and key socio-demographic groups. The more individuals visited nature for recreation and the more they appreciated the natural world, the more pro-environmental behaviour they reported. Although rural and coastal dwellers tended to also be more pro-environmental on average, patterns were complex, potentially reflecting situational constraints and opportunities. Importantly, positive associations between pro-environmental behaviours and high neighbourhood greenspace and coastal proximity were present for both high and low socio-economic status households. Improving access to, and contact with, nature, e.g., through better urban planning, may be one approach for meeting sustainability targets. Keywords: Nature contact, Natural environment exposure, Green space, Pro-environmental behavior, Sustainable behavior, Green lifestyle

The integrated study of ocean health and human health is an emerging area of increasing global importance. Growing evidences demonstrate that the health of the ocean and the health of humans have always been and will continue to be, inextricably linked. Our actions toward the oceans will significantly influence the future of the whole planet and, in turn, our own health. The current review of these issues arose from a summer school in San Sebastian (Spain), from 5th to 7th June, 2019. An interdisciplinary group of researchers discussed key risks (e.g., microbial pollution, pharmaceuticals, harmful algal blooms, plastic pollution) and benefits (e.g., bathing waters, recreation, tourism) of the seas and global ocean for humanity; and debated the future priorities and potential actions for a joint Oceans and Human Health research and governance programme in Europe. The aim of this review is to contribute to the emerging scientific agenda on ocean health and human health, as well as coordinate efforts with stakeholders, policy makers and the general public. This agenda operates within the larger context of the upcoming United Nations Decade of Ocean Science for Sustainable Development: 2021–2030, which strives to achieve the Sustainable Development Goals (SDG), including healthy (human) lives and well-being (SDG3) and conserving and sustainably using the oceans (SDG14), among others. In addition to summarizing some of the key risks and benefits, therefore, we describe the governance of oceans and health interactions (especially in Europe), and we finish by proposing a list of elements for potential future research priorities on oceans and human health.

Background: Evidence suggests that living near blue spaces such as the coast, lakes and rivers may be good for health and wellbeing. Although greater levels of physical activity (PA) may be a potential mechanism, we know little about the types of PA that might account for this. Objectives: To explore the mediating role of: a) ‘watersports’ (e.g. sailing/canoeing); b) ‘on-land outdoor PA’ in natural/mixed settings (e.g. walking/running/cycling); and, c) ‘indoor/other PA’ (e.g. gym/squash) in the relationships between residential blue space availability and health outcomes. Methods: Using data from the Health Survey for England (n = 21,097), we constructed a path model to explore whether weekly volumes of each PA type mediate any of the relationships between residential blue space availability (coastal proximity and presence of freshwater) and self-reported general and mental health, controlling for green space density and a range of socio-economic factors at the individual- and area-level. Results: Supporting predictions, living nearer the coast was associated with better self-reported general and mental health and this was partially mediated by on-land outdoor PA (primarily walking). Watersports were more common among those living within 5kms of the coast, but did not mediate associations between coastal proximity and health. Presence of freshwater in the neighbourhood was associated with better mental health, but this effect was not mediated by PA. Conclusions: Although nearby blue spaces offer potentially easier access to watersports, relatively few individuals in England engage in them and thus they do not account for positive population health associations. Rather, the benefits to health from coastal living seem, at least in part, due to participation in land-based outdoor activities (especially walking). Further research is needed to explore the mechanisms behind the relationship between freshwater presence and mental health. Keywords: Physical activity, General health, GHQ-12, Water, Restoration, Green exercise

Cities are responding to their growing transportation demands in different ways. We interviewed city dwellers in two cities, Singapore and London, with highly developed transport infrastructure to understand individual transport decisions and experiences in the context of two different city cultures that support distinct transport policies. Compared to London, cars and other private transport are valued and priced beyond the reach of most in Singapore. Seventeen adults from London and sixteen from Singapore were interviewed and presented with an overview of the other city's transportation system to elicit their opinions on the differences and whether an alternate system could be applied in their city. Differences were observed in perceptions of, and beliefs concerning, private transport. In Singapore, cars served more than utilitarian purposes and were viewed as socially desirable status and success symbols. In London, car ownership and usage were viewed as a necessity due to a perceived lack of accessible, alternative transport. Both samples valued accessibility, affordability and comfort in relation to transport mode choice. There was also general acknowledgement and support for managing the car population and use in both cities, though how it should be done remains highly context-specific. Our findings suggest that public engagement and effective communication are important components when interventions and policies are introduced to better manage the car population and use in cities.

Aim: To report on the acceptability of virtual reality (VR) nature environments for people with memory loss at memory cafes, and explore the experiences and perceptions of carers and staff. Methods: A qualitative study was conducted between January and March 2019. Ten adults with memory loss, eight carers and six volunteer staff were recruited from two memory cafes, located in Cornwall, UK. There were 19 VR sessions which were audio recorded and all participants were interviewed at the end of the sessions. Framework analysis was used to identify patterns and themes in the data. Results: During the VR experience, participants were engaged to varying degrees, with engagement facilitated by the researcher, and in some cases, with the help of a carer. Participants responded positively to the nature scenes, finding them soothing and evoking memories. The VR experience was positive; many felt immersed in nature and saw it as an opportunity to ‘go somewhere’. However, it was not always positive and for a few, it could be ‘strange’. Participants reflected on their experience of the VR equipment, and volunteer staff and carers also shared their perceptions of VR for people with dementia in long-term care settings. Conclusions: The VR nature experience was an opportunity for people with memory loss to be immersed in nature and offered the potential to enhance their quality of life. Future work should build on lessons learned and continue to work with people with dementia in developing and implementing VR technology in long-term care settings.

Studies using the Ultimatum Game have shown that participants reject unfair offers extended by another person although this incurs a financial cost. Previous research suggests that one possible explanation for this apparently self-defeating response is that unfair offers involve strong negative responses that decrease the chances of responders accepting offers that would objectively constitute a net profit. We tested the hypothesis that one way of reducing responders’ rejections of unfair offers is through increased psychological distance, so that participants move away from the concrete feeling of being unfairly treated. Social distance was manipulated by having participants play the Ultimatum Game either for themselves, or for another person. Compared to deciding for one’s self or a close social contact, participants showed less sensitivity to fairness when deciding for a stranger, as indicated by fewer rejected unfair offers. We suggest that social distance helps people move beyond immediate fairness concerns in the Ultimatum Game.

Excess choice has previously been shown to have detrimental effects on decisions about consumer products. As the number of options increases, people are more likely to put off making an active choice (i.e., defer) and show less satisfaction with any purchase actually made. We extend this line of enquiry to choosing a charitable organisation to volunteer for. The issue is important because the number of voluntary organisations is enormous and the impact of such a decision may be greater than for consumer decisions in terms of time commitment and benefits to the volunteer and society. Study 1 asked students to examine a real volunteering website and record how many organisations they considered, decision difficulty and whether or not they would like to sign up for a chosen organisation or prefer to defer a decision. Study 2 presented either a relatively small (10) or large (30) choice set of hypothetical organisations and measured deferment likelihood and decision difficulty. In both studies the more options considered, the greater the likelihood to defer. This effect was mediated by decision difficulty. This research is the first to find that detrimental effects of excess choice extend to volunteering. Implications for volunteer recruitment are discussed.

Increasingly, the potential short and long-term impacts of climate change on human health and wellbeing are being demonstrated. However, other environmental change factors, particularly relating to the natural environment, need to be taken into account to understand the totality of these interactions and impacts. This paper provides an overview of ongoing research in the Health Protection Research Unit (HPRU) on Environmental Change and Health, particularly around the positive and negative effects of the natural environment on human health and well-being and primarily within a UK context. In addition to exploring the potential increasing risks to human health from water-borne and vector-borne diseases and from exposure to aeroallergens such as pollen, this paper also demonstrates the potential opportunities and co-benefits to human physical and mental health from interacting with the natural environment. The involvement of a Health and Environment Public Engagement (HEPE) group as a public forum of “critical friends” has proven useful for prioritising and exploring some of this research; such public involvement is essential to minimise public health risks and maximise the benefits which are identified from this research into environmental change and human health. Research gaps are identified and recommendations made for future research into the risks, benefits and potential opportunities of climate and other environmental change on human and planetary health.

Dental anxiety creates significant problems for both patients and the dental profession. Some distraction interventions are already used by healthcare professionals to help patients cope with unpleasant procedures. The present study is novel because it a) builds on evidence that natural scenery is beneficial for patients, and b) uses a Virtual Reality (VR) representation of nature to distract participants. Extending previous work that has investigated pain and anxiety during treatment, c) we also consider the longer term effects in terms of more positive memories of the treatment, building on a cognitive theory of memory (Elaborated Intrusions). Participants (n = 69) took part in a simulated dental experience and were randomly assigned to one of three VR conditions (active vs. passive vs. control). In addition, participants were distinguished into high and low dentally anxious according to a median split resulting in a 3×2 between-subjects design. VR distraction in a simulated dental context affected memories a week later. The VR distraction had effects not only on concurrent experiences, such as perceived control, but longitudinally upon the vividness of memories after the dental experience had ended. Participants with higher dental anxiety (for whom the dental procedures were presumably more aversive) showed a greater reduction in memory vividness than lower dental-anxiety participants. This study thus suggests that VR distractions can be considered as a relevant intervention for cycles of care in which people's previous experiences affect their behaviour for future events.